Skip to main content

What do Neonatal ICU levels mean?

You may have heard that Huntsville Hospital for Women & Children has a Level III Neonatal ICU and that Madison Hospital has a Level II Special Care Nursery. But what does that mean?

Neonatal refers to the first 28 days of life. Some babies require more advanced care during these first days because they were born prematurely or with certain medical conditions. Our community is fortunate to have access to this specialized care, but understanding the different levels of neonatal care can be confusing.

It’s important for expectant parents to learn about neonatal care especially if they are aware of a risk for premature birth or congenital defect. Alabama law does not require hospitals to meet certain standards in order to claim an elevated level of care, so I recommend that parents talk directly with their hospital to be sure they understand the specialty care available.

As recently as 2012, the American Academy of Pediatrics (AAP) published a policy statement which recommends “uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes.” The AAP also listed the following classifications for neonatal care:

  • Level I
    A hospital nursery able to evaluate and provide care of healthy newborn infants and babies born as early as 35 weeks whose condition is stable;
  • Level II
    A hospital special care nursery able to care for infants born at 32 weeks’ gestation or more and weighing 1500 g (3.3 lbs) or more at birth;
  • Level III
    A hospital neonatal ICU that provides specialized care for premature babies and babies with critical illness. Level III units routinely provide ongoing assisted ventilation, have ready access to a full range of pediatric medical subspecialists, and have advanced imaging with interpretation on an urgent basis;
  • Level IV
    A hospital neonatal ICU with the same capabilities as a Level III NICU but can also provide surgical repair of serious congenital or acquired malformations.

Huntsville Hospital for Women & Children has the only Level III Neonatal ICU (NICU) in North Alabama. It is staffed by a team of five board certified Neonatologists and a Neonatal Hospitalist. Our physician team is supported by neonatal nurse practitioners and neonatal registered nurses certified by the American Heart Association’s Neonatal Resuscitation Program (NRP). Many also hold an additional Neonatal Intensive Care Certification.

Also unique to North Alabama, several of our nursing team members make up an innovative dedicated Small Baby Team, which is specially trained to care for the smallest and sickest babies. The NICU routinely adopts innovative care practices like the Small Baby Team as well as advanced treatment methods including high frequency oscillatory ventilation, nitric oxide and induced therapeutic hypothermia. Recently the hospital opened the region’s only Infant Nutrition Lab.

The same highly qualified physician team at Women & Children also oversees the care of babies in Madison Hospital’s Level II Special Care Nursery, allowing families who live in communities closer to Madison more specialized services than a Level I hospital nursery.

By Lee Morris, MD

Lee Morris, M.D.
Huntsville Hospital for Women & Children Level III Neonatal ICU

Know your options for pain management in childbirth

Your pregnancy brings with it many choices. You pick a physician, a hospital, baby names, paint colors and the list of decisions doesn’t stop there. Making an informed choice about pain management during labor and childbirth should be at the top of your decisions list. Some of the pain management options discussed below are not available to everyone because of existing medical conditions and side effects. Your OB-GYN can help you determine what’s best for you and, at the very least, needs to know your preferences and expectations.

Natural Childbirth

Nursing staff at both Huntsville Hospital for Women & Children and Madison Hospital are experienced with helping women through natural childbirth, which is childbirth with no medications. Many women want to prepare for natural childbirth by relying on techniques such as relaxation and controlled breathing to manage pain. The best way to learn more about and practice these techniques is through a certified childbirth class. We have a variety of labor tools including birthing balls and birthing stools. With your physician’s approval, you can also labor immersed in water, called hydrotherapy. At Women & Children this can be done in your room’s bathtub. At Madison Hospital, our staff is happy to accommodate hydrotherapy but you will need to bring your own inflatable tub. It’s important to understand that circumstances may arise during labor that lead to a determination by your care team that hydrotherapy is not a safe option.

Nitrous Oxide (laughing gas)

Nitrous oxide is a colorless, odorless gas that’s mixed with oxygen and used to help pregnant women cope with labor pains during active labor. It does not numb any part of your body and doesn’t reduce pain like a narcotic, but it can reduce anxiety and provide a disassociation from your pain. This means you might still feel pain, but you won’t be as bothered by it.

Patients inhale the gas through a mask placed over the nose and mouth. It is self-administered so women can use it as needed during labor, pushing, and after-birth repair. Nitrous oxide quickly leaves the body’s system in three breaths allowing laboring moms to walk, stand and use other labor techniques in combination with nitrous oxide.

Nitrous oxide has no negative effects on fetal heart rate and it does not affect breastfeeding or breast milk. It cannot be used if you are receiving pain medicine through an IV.


An epidural is technique of using a catheter – a very thin, flexible, hollow tube – that’s inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. The catheter delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. This is a popular choice for women who don’t want to feel pain but also don’t want to feel medicated or “fuzzy” during labor and childbirth. With an epidural, you must stay in bed because it causes your abdomen and legs to feel numb. Before the procedure to place the epidural can begin, you will provide written consent, your physician must write the order, your nurse will start an IV to deliver fluids and your blood will be collected for lab tests. Some women may also need a urinary catheter.

IV Sedation

Pain medicine can also be given through an IV. Typically this method of pain control causes the mother to feel sedated because the medicine distributes throughout the entire body. Women who use IV sedation must stay in bed to labor because they are at risk of falling.

By Jade LeCroix, RN and Renee Colquitt, CRNP

Jade LeCroix, RN
Jade LeCroix, RN
Jade is the Director of the Labor & Delivery Unit, Antepartum Unit and OB/GYN Emergency Department at Huntsville Hospital for Women & Children.
Renee Colquitt, CRNP, NNP-BC
Renee Colquitt, CRNP, NNP-BC
Renee is the Director of Perinatal Services at Madison Hospital.

Why we needed breastfeeding support

A collection of thoughts and comments from members of our breastfeeding support groups

Madison Hospital and Huntsville Hospital for Women & Children host several breastfeeding support groups on their campuses. An Internationally Board Certified Lactation Consultant facilitates the group and provides assistance to mothers in attendance. At their request, we’re sharing thoughts and comments from these appreciative breastfeeding moms.

I was ready to quit and give up on breastfeeding. I hated pumping and didn’t feel like I was getting enough to keep with it, but my husband encouraged me to call breastfeeding support. I found the group experience to be nothing like what I’d thought it was going to be. It was welcoming and forgiving, and I wished I’d gone sooner.

It’s a place to go to get help, but it was also a great opportunity to connect with other moms, which made me feel like I had a team who really wanted me to succeed. I needed this outlet to express my frustration of knowing I had enough milk, but still not being able to get my baby to breastfeed. I needed to talk with other moms who were having their own challenges – and triumphs. I learned that I had experiences that could help some less experienced moms, and at the same time I was learning from other veteran moms.

I would encourage every Mom to attend the breastfeeding support group. We’re five months strong now, and I know I’ll continue to attend on Saturdays with Harper until we reach a year.

Amanda is a nursing mom of two. She breastfed her son for one year until her son self-weaned when she became pregnant with her daughter. She’s been breastfeeding her daughter for six months.

I wanted to have a successful breastfeeding relationship, and I needed help weening myself off a nipple shield. But, the single most valuable thing I learned was that I was enough for my child. My nursing relationship with my baby has been so easy because of the support I have through this group. Now I’ve realized that this is my passion. I’ve decided to become a certified lactation consultant.

Jessica is a first-time mom to a 14-month-old boy. She has lived in the Madison area for three years with her husband, Ethan. She works part time as an office manager and hopes to become an International Board Certified Lactation Consultant in the future.

When I went back to work my baby became frustrated at the breast. I started coming to the support group to get help to keep him at the breast and now I feel much more confident in my ability to breastfeed. On top of that, I have found friends for my son and for myself and I have more emotional support than I could of ever imagined.

Lauren is a first-time mom to an 18-month-old son who was born four weeks early and spent eight days in the Neonatal ICU at Huntsville Hospital for Women & Children. He is now thriving and exclusively breastfed.

I joined the support group because it had been five years since I breastfed my first set of twins. Although I had learned a lot of new breast-feeding information from a breastfeeding class I attended, I needed assistance to help my baby girl latch. She was significantly smaller than her brother and spent some time in the NICU, which meant she had some extra challenges.

The lactation consultants taught me how to supplement with formula appropriately so both my babies would benefit from my breast milk, and I could ensure they received all the nutrition they needed to grow. They also helped me realize that I am doing the best I can for my babies.

I really appreciate the support towards breastfeeding but also their support when I’ve had to use formula to supplement. They celebrate the small and big victories with everyone. I really enjoy getting out each Tuesday to see how my babies have grown and talk about the successes and challenges we have faced the week prior. This is an amazing group of LC’s, mothers and babies.

Anya is nursing mom of two sets of twins – five-year-old fraternal boys and four- month-old boy/girl fraternal twins. She nursed her first set of twins for one year and is breastfeeding her younger twins with some formula supplementing.

What’s in a birth plan and do you need one?

The birth of a child is an amazing and wondrous event. It can also be scary, especially if it’s your first. The fear of the unknown can be crippling and terrifying. A birth plan is a way to communicate your wishes to those caring for you during your labor and after the birth of your baby. It is a tool to let the team caring for you know about your preferences.

When you pick your obstetrician, you are choosing the person who will play a huge part in the most amazing, wonderful and scary event in your life. Your obstetrician should be a partner – someone you trust with your new bundle of joy. As obstetricians, we are there to inform, guide and assist in this most intimate moment.

But in order to give you the very best birth experience, we need to have a detailed understanding of your preferences. That’s where the birth plan comes in.

Birth plan worksheets and templates can be found in pregnancy books and of course, online. No matter where you find the template, the birth plan should be a simple, clear, one- or two-page statement of your preferences. Many women, especially first time moms, may need to talk with their doctor to help them decide what their preferences are.

Typical birth plans will include preferences for:

  • Pain medication (none, IV, epidural or nitrous oxide)
  • Movement/position during labor and delivery
  • Labor props (tub, birthing ball, squatting bar, stool, etc.)
  • Induction/intervention/augmentation (breaking of water, pitocin)
  • Support people (spouse, parents, Doula, extended family)
  • Fetal monitoring (intermittent vs. continuous)
  • Position and timing of pushing
  • Episiotomy
  • Delivery assistance (vacuum, forceps)
  • Fluid management (to have an intravenous line (IV) or not) and food/liquid intake
  • Ability to photograph or video (this will differ at each facility and with each health care provider)
  • Environmental preferences (lights, music, scents, etc.)

After delivery preferences

  • Cord clamping
  • Skin to skin (putting baby on your bare skin immediately following delivery)
  • Medication/bathing
  • Breastfeeding vs. bottle feeding
  • Pacifier use
  • If male child – circumcision

Keep in mind you can’t control every aspect of labor and delivery. During childbirth many women feel like they are losing control. A birth plan can help maintain focus and it also serves as a refresher for your healthcare provider and serves to inform new members of your medical team about your preferences when you are in active labor.

A birth plan can be a way to ‘marry’ your idea of the birth experience with the obstetrician’s idea of a safe and ‘normal’ labor and delivery. It is important to ensure that everyone is on the same page and is comfortable with the plan of care. Also, each hospital and obstetrical department has its own policies and procedures. Discussing the birth plan gives an opportunity to gain information about those policies and procedures.

It is important to stay flexible in case something comes up that requires your birth team to depart from your plan. Remember, the important thing is having a safe birth.

Our goal with every new mom (and dad) is to have a happy healthy mom and a healthy baby.

By Whitney Dunham, MD

Whitney Dunham, MD

Whitney Dunham, M.D.
Dr. Dunham is the Medical Director of the OB Hospitalist Program at Huntsville Hospital for Women & Children. She also cares for patients at Huntsville Hospital Obstetrics & Gynecology.